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Release: May 16, 2002

Care needed to avoid diabetes and pregnancy complications

While many people understand the dangers of diabetes, they usually underestimate how it complicates a pregnancy. Diabetes is one of the leading causes of birth defects in the United States. Complications of diabetes also include large birth weight, excessive amounts of amniotic fluid, and preeclampsia (also referred to as toxemia of pregnancy) which involves increased blood pressure, headaches, protein in the urine and swelling in the lower extremities.

Diabetes is characterized by the body's inability to produce or use insulin. Insulin regulates the amount of glucose (sugar) in the body. Type 1 diabetes occurs when the body is unable to produce insulin, and Type 2 diabetes occurs when the body is unable to use the insulin the body makes. University of Iowa Health Care experts have developed many services to help patients decrease risks and maintain healthy diabetes control. These services include the diabetes and high-risk obstetrics clinics that provide preconception care.

Uncontrolled diabetes before conception and up to the first eight weeks of pregnancy can cause major birth defects and spontaneous abortions. During the second and third trimesters of pregnancy, uncontrolled glucose levels can result in excessively large babies, creating risks to the mother and the child. As a result, women with diabetes are more likely to have cesarean deliveries.

Despite these risks, women with diabetes are able to have successful and healthy pregnancies. "It just takes a little work and commitment," said Vicki Kraus, Ph.D., a UI advanced registered nurse practitioner in internal medicine and the obstetrics clinic. "Committing to a regimen and seeking out support through physicians and nurses and from family members can lead to success."

Stephen Hunter, M.D., Ph.D., a UI associate professor of obstetrics and gynecology who specializes in high-risk pregnancies, stresses the importance of preconception care in order to reduce risks.

"Not only does preconception care allow us to make sure the patient has normal blood sugar levels, it also gives us a chance to look for other conditions which may further complicate a pregnancy," Hunter said. "In addition, preventive care allows us to educate the family. We use a team approach that involves nurses, physician specialists, dietitians, psychologists and social workers in order to optimize outcomes."

According to the National Institute of Diabetes and Digestive and Kidney Diseases, 10 to 18 percent of non-pregnant woman ages 20 to 44 years have some type of abnormal glucose tolerance that would be associated with fetal or maternal risks if those women became pregnant.

Diabetes creates complicated and high-risk pregnancies. However, both Kraus and Hunter emphasize that, with proper health care awareness, resources and support, pregnancy is not something that has to be avoided.

For younger patients, diabetes is a special concern. Because this is the age teenagers may experiment with sex and want as much self-control as possible over their lives, diabetes often acts as a second parent, limiting the way the teen can eat, exercise and act. Consequently, some teenagers with diabetes do not have adequate regulation or control of the disease. As a result, pregnancies in teens are further complicated. Health care providers stress the importance of maintaining an insulin regimen and staying healthy.

Primary care physicians also play an integral role in the preventive process. Routine preventive care stresses the importance of diabetes control and the potential dangers of pregnancy, as primary care physicians inform patients about risks and direct them to other resources, if needed.

"Physicians should routinely be asking female patients about their diabetes and their plans regarding pregnancy. The patient should be informed that blood sugar levels should be normal before conception," Kraus said.

As with all medical care, it is best to consult your personal physician before making any changes to your health care routine.

If you have concerns about diabetes and pregnancy or would like more information, call UI Health Access at (319) 384-8442 or toll-free at (800) 777-8442 and ask to speak to the UI Intensive Insulin Therapy Clinic.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.